Infections — what antibiotics are used for spider bites?

Infections — what antibiotics are used for spider bites?

Responses (5)

If they are infected, you need to see a dr. Depending on the spider they can get nasty pretty fast. Drugs like keflex are used for the infection.

Do you know what the spider was? I was bitten by a brown recluse spider and waited three days to get to a doctor. By then it was IV vanc (draino) and operations to stop the progress of the tissue death. Maybe you should get in to a medical clinic. If you have the spider take it with you to the clinic.

Do not know which kind of spider and this happened several weeks ago. Appeared to be getting better then I woke up to a swollen red foot. I was given some penicillin from a friend but have not taken them. I have been keeping foot elevated and this morning swelling was down but is back after being on my feet most of the day.

Doxycycline Can this antibiotics be used for a spider bite ? I don’t know what kind of spider it was

Dont know what spider. 3 days ago. Hospital lanced drained and packed bite. What antibiotic?

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Lyme disease

Medically reviewed by Drugs.com. Last updated on Jun 3, 2019.

What Is It?

Lyme disease is an infection caused by bacteria called Borrelia burgdorferi. These bacteria are transmitted through the bites of ticks, primarily the deer tick. Not everyone who develops symptoms of Lyme disease remembers getting bitten by a tick because the deer tick is very small and its bite can go unnoticed.

Lyme disease is most common in the northeastern and upper mid-western United States. More than 90% of cases have been reported in nine states: Connecticut, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin. Even within states, there are regions of high risk and others with very low rates of disease. This variation relates to where ticks that carry the bacteria live, breed and come into contact with humans.

Late spring and early summer are the peak times of the year for Lyme disease to be diagnosed. However, the condition is not always diagnosed right away. So, cases still are identified all year long.

Deer ticks can carry other germs, such as Anaplasma, Babesia, and Borrelia miyamotoi. It’s not uncommon for people to have one of these infections in addition to Lyme disease.

Symptoms

The usual first symptom is a rash called erythema migrans (EM), which is usually a flat, reddish rash that spreads from the site of the tick bite. The rash usually is larger than 2 inches wide and can grow larger. It often develops a central clear area known as a bull’s eye. The rash usually doesn’t itch or hurt. Other symptoms at this stage can include fever, muscle and joint aches, fatigue, headache and a severe stiff neck. In some cases, there are two or more of these well-defined rashes.

Over several days to weeks after the tick bite, Lyme disease can cause other problems. It can affect the nervous system. For example, it can cause Bell’s palsy. The nerve that controls most of the facial muscles can become inflamed and the muscles get weak. The infection can get into the fluid that surrounds the brain and spinal cord, causing a type of meningitis.

Lyme disease also can affect the heart. The most common problem is a very slow heartbeat that leads to fatigue, dizziness and fainting. The heart muscle can also be inflamed, called myocarditis.

Lyme disease also can cause pain and swelling of joints. The arthritis commonly affects one knee or episodes of swelling in several joints, called migratory arthritis. The symptoms can become persistent.

In later stages of Lyme disease, patients can experience problems with memory and concentration.

Diagnosis

Your doctor will ask about your symptoms and perform a complete physical and neurological examination. If you have had a recent tick bite and have saved the tick, your doctor may want to inspect the insect and send it to a laboratory to identify the species. Some laboratories can analyze the tick to see if it’s carrying Lyme bacteria.

Your doctor will diagnose Lyme disease based on your symptoms and the examination. Blood tests are often negative in the first few weeks of Lyme disease. The basic Lyme test is called an ELISA (enzyme-linked immunosorbent assay). However, this test often gives a false-positive result, that is, a positive result in someone who doesn’t have the illness. Therefore, every positive or uncertain Lyme ELISA result needs to be confirmed with a test called a Western blot, which looks for more specific evidence of Lyme disease infection.

A positive Lyme blood test, even including a Western blot, doesn’t mean that the disease is active and needs to be treated. This is because blood tests can remain positive for years, even after Lyme disease has been treated or has become inactive. To help diagnose Lyme disease and to check for other causes of symptoms, a sample of fluid may be withdrawn from an affected joint using a sterile needle. Cerebrospinal fluid also may be taken from around the spinal cord through a spinal tap (lumbar puncture), to test for Lyme disease antibodies and inflammation and check for other diseases.

Expected Duration

People often recover within two to six weeks without antibiotics. Even Lyme arthritis often improves on its own as the body’s immune system attacked the infection, although it’s common for it to return. Antibiotic therapy is highly effective at curing the illness. Significant improvement occurs within two to six weeks after beginning therapy.

Prevention

If you are in a region where Lyme disease is more common, you can:

Avoid woods, high brush, and grasses where ticks hide

Wear long pants and long sleeves; white clothing makes is easier to spot ticks

Examine your skin for ticks soon after returning from wooded areas or areas with high grass or brush

Apply tick repellents (especially those that contain DEET) to the skin and clothing

Antibiotics are not prescribed for every tick bite, because the risk of getting Lyme disease is quite low, ranging from less than 0.1% in most areas to 5% in some areas of the Northeast and Midwest. For people that live in areas where Lyme disease rates are high, one dose of doxycycline can usually prevent disease if taken within three days of a tick bite. So for those at highest risk, early treatment may be appropriate. A Lyme disease vaccine is not currently available for humans.

Treatment

For the early Lyme EM rash, doctors usually prescribe two to three weeks of antibiotics. Doxycycline is the preferred treatment. Alternative antibiotics include amoxicillin and cefuroxime (Ceftin).In people who have developed Bell’s palsy, arthritis or carditis, this antibiotic treatment often is extended to four weeks.

Some people with heart or neurological problems will be treated with antibiotics such as ceftriaxone (Rocephin) given intravenously (into a vein) for two to four weeks. Intravenous treatment also may be recommended if a person with Lyme arthritis does not respond to oral antibiotics. Doxycycline should be avoided in children less than 8 years old and for women who are pregnant or nursing. Erythromycin, azithromycin or clarithromycin may be less effective but are often prescribed for people with Lyme disease who can’t tolerate the other options mentioned above.

When To Call a Professional

Call your doctor if you develop a rash or flulike illness after you have been bitten by a tick or you could have been exposed to ticks. You should also call your doctor if you have facial paralysis, arthritis, or persistent dizziness or heart palpitations.

If you are taking oral antibiotics for Lyme disease and your symptoms do not improve within two to three weeks, call your doctor.

Prognosis

People with the Lyme disease rash rarely have problems after they are treated with antibiotics. In some cases, people become extremely tired after being treated for Lyme disease, but this problem doesn’t tend to improve with additional antibiotics. The medical reason for this fatigue is uncertain. Many, and perhaps most, people with persistent symptoms have no clear evidence of active infection. Intensive antibiotic treatment (for example, intravenous treatment for prolonged periods) usually doesn’t help.

Up to 10% of people with Lyme arthritis appear to have chronic (long-lasting) joint swelling despite taking antibiotics. Recent evidence suggests this is caused by an autoimmune effect, in which Lyme infection triggers the immune system to attack the body’s own cells. This problem seems to follow Lyme disease primarily in people of certain genetic types. These people may respond to medications that suppress the immune system (similar to those used in rheumatoid arthritis) rather than to continued antibiotics.

Learn more about Lyme Disease

Associated drugs

IBM Watson Micromedex

Mayo Clinic Reference

External resources

Infectious Diseases Society of America
1300 Wilson Blvd.
Suite 300
Arlington, VA 22209
Phone: 703-299-0200
Fax: 703-299-0204
http://www.idsociety.org/

Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA 30333
Phone: 404-639-3534
Toll-Free: 1-800-311-3435
http://www.cdc.gov/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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7 Antibiotics Often Used To Treat Infections In Dogs

It is quite common for dogs to suffer from bacterial infections and diseases. For common bacterial illnesses, the treatment usually involves bacteriostatic antibiotics or bactericidal antibiotics depending on the condition. The bacteriostatic antibiotics inhibit the growth of bacteria to multiply through prevention, while the bactericidal antibiotics kill the bacteria. These antibiotics are available in capsules, chewable tablets, ointments and liquids, and it is important for you as a dog owner to be informed about these antibiotics and how they can affect your pet.

Learning More About Antibiotics For Dogs

While over the counter antibiotics are usually safe on dogs, it is still best that a sick dog is seen by a vet to determine the best treatment to be given because each dog is different and every health condition is also different. Dogs can develop allergic reactions to antibiotics so caution is always needed especially to avoid overdose.

1. Amoxicillin And Cephalexin

These are common antibiotics used for bacteria related illnesses and are related to penicillin. Amoxicillin is used to treat the gastrointestinal, respiratory and genitourinary systems of dogs, as well as skin infections. The typical dosage for amoxicillin is 10mg for every pound of body weight for every 8 to 12 hours. Cephalexin is used to treat various infections, but it is primarily used to treat wound, skin and bone infections. The dosage for cephalexin is 10mg to 15mg per every pound of body weight for every 8 to 12 hours. However, due to the possible effects of cephalexin, prescription from a vet is necessary.

2. Sulfamethox

This antibiotic is strictly used for various infections as well as urinary tract infections in dogs. However, it is important that plenty of water is drunk when this is taken and side effects include nausea, loss of appetite, vomiting and diarrhea.

3. Gentamicin

Pneumonia, ear infections and eye infections can be treated with this antibiotic alone or with a combination of anti-inflammatory medication. This is available in tablets as well as a topical spray.

4. Chloramphenicol

This antibiotic contains a certain level of pH that can go through a dog’s body completely to treat bacteria and parasite infections. It can also enter the organs of a dog to battle infections making it a popular antibiotic.

5. Sulfadimethoxine

Also known as sulfa drugs, this antibiotic is specifically used to treat parasitic infections that cause gastrointestinal conditions in dogs.

6. Tetracycline

Protection against a variety of bacterial infections can be derived from tetracycline as it does not allow proteins to synthesize. However, infections are easily treated with this antibiotic because it has the ability to break through barriers that hinder treatments of infections.

7. Doxycycline

This is similar to tetracycline and it is also used in a variety of infections to prevent growth and production.

Allergic Reactions To Antibiotics

Allergic reactions can occur and depend on the type of antibiotic taken, as well as its dosage. Most of the time, the symptoms of allergic reactions occur within 24 hours, but they often last for a few hours after treatment is sought. The common reactions include breathing difficulty, painful rashes, itchiness, coughing, nausea, unable to eat and swelling. In severe cases of allergic reactions, dogs can experience anaphylactic shock which requires immediate medical attention.

Citations:
Featured images:
  • License: Royalty Free or iStock source: http://mrg.bz/Cuwtiu

Valerie Lawrence is a freelance writer specializing in animal health and nutrition. She also offers information about the various medications given to dogs and she also recommends vet clinic for any type of health concern in pets.

mehimandthecats.com

Antibiotics for Treating Infections

Andy Miller, MD, is board-certified in internal medicine and infectious disease. He is an associate professor at Weill Cornell Medicine in New York City.

Andrew Brookes / Getty Images

Have you ever wondered what antibiotics are? Have you ever wondered how they work? These “miracle drugs” were a big breakthrough of the 20th century. They let many people live. There were many fewer deaths from infectious diseases.

There are, however, misconceptions about antibiotics. One common misconception is that you should take antibiotics until you feel better. Many, wrongly, believe they can stop antibiotics when they feel better, even if their doctor had asked them to take the antibiotic for longer. Did you know that by not following doctors’ orders on antibiotic prescriptions, you could end up with even greater health problems than what you began with?

There are now bacteria that resist antibiotics. These are called antibiotic-resistant bacteria because the drugs no longer stop these bacteria (or don’t stop them quick enough). This is very dangerous for all of us. It can be scary. It is important that everyone understands how antibiotics work. We should work together to clear up any misconceptions about antibiotics. If we let these misconceptions continue, many people can get sick from drug-resistant bacteria. There may not be the drugs to treat these bacteria.

Listed below are several important points that we all should consider before starting any antibiotic treatment.

What Are Antibiotics?

Antibiotics are medications that kill or stop the growth of bacteria. They do this by blocking important functions within the bacteria cell. These drugs include topical over-the-counter antibiotic creams and ointments that you spread over your skin. They also include pills you swallow and intravenous solutions that are injected into your vein. These drugs stop minor bacterial infections, as well as life-threatening system-wide infections.

There are many types of antibiotics, which can be used topically (on the skin, like an ointment), orally (pills for adults or liquid for kids to swallow), or intravenously. Each antibiotic kills different groups of bacteria.

Early antibiotics were discovered and isolated from molds. Molds can be dangerous. Many infections are caused by molds and different types of fungi. In this case, though, molds were very useful.

These antibiotic molecules were produced by the molds to be used as a defense against bacteria. We «stole» these from the molds and started to treat infections with these. More recently, newer classes of antibiotics have been created in laboratories. Because the targets of antibiotics are (often) specific to bacterial rather than human cells, they generally have few side effects and are considered safe for the vast majority of people.

Side Effects

While antibiotics are safe for most people, a small number of people are prone to allergic reactions. These allergic reactions can be to penicillin or other antibiotics (like Bactrim or Cotrim). Symptoms include rash, throat tightening or swelling, difficulty breathing, swollen lips, a rash or hives, gastrointestinal problems, light-headedness, loss of consciousness, and low blood pressure. In rare cases, people can die from allergies. If you suspect you have an allergy to an antibiotic, immediately stop using it and contact your physician or healthcare provider.

Other common side effects of antibiotics may include diarrhea and yeast infections. These occur because antibiotics can affect the natural balance of the bacteria that are part of our microbiome. There have been many studies looking at how to preserve or replace good bacteria, and few have shown that probiotics can help with anything other than C.difficile; further research needs to be done in this area.

Antibiotics can interfere with birth control, and decrease efficacy, so it’s important to talk to your doctor before taking them.

Drug resistance can also develop. This can happen when people take antibiotics «just in case» like when they are traveling and develop a bit of diarrhea, but are not sick. It can also happen when drug use isn’t monitored when people have to take antibiotics for a long time. The resistances that develop may initially be found in hospitals, but later spread out into the community. The result can be antibiotic resistances accumulating that we don’t have good antibiotics to treat.

www.verywellhealth.com

Lyme disease

NICE guideline [NG95] Published date: 11 April 2018 Last updated: 17 October 2018

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Guidance

Recommendations

Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off‑label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 Awareness of Lyme disease

1.1.1 Be aware that:

the bacteria that cause Lyme disease are transmitted by the bite of an infected tick

ticks are mainly found in grassy and wooded areas, including urban gardens and parks

tick bites may not always be noticed

infected ticks are found throughout the UK and Ireland, and although some areas appear to have a higher prevalence of infected ticks, prevalence data are incomplete

particularly high-risk areas are the South of England and Scottish Highlands but infection can occur in many areas

Lyme disease may be more prevalent in parts of central, eastern and northern Europe (including Scandinavia) and parts of Asia, the US and Canada.

1.1.2 Be aware that most tick bites do not transmit Lyme disease and that prompt, correct removal of the tick reduces the risk of transmission.

1.1.3 Give people advice about:

where ticks are commonly found (such as grassy and wooded areas, including urban gardens and parks)

the importance of prompt, correct tick removal and how to do this (see the Public Health England website for information on removing ticks)

covering exposed skin and using insect repellents that protect against ticks

how to check themselves and their children for ticks on the skin

sources of information on Lyme disease, such as Public Health England, and organisations providing information and support, such as patient charities.

To find out why the committee made the recommendations on awareness of Lyme disease and how they might affect practice, see rationale and impact.

1.2 Diagnosis

Clinical assessment

1.2.1 Diagnose Lyme disease in people with erythema migrans, a red rash that:

increases in size and may sometimes have a central clearing

is not usually itchy, hot or painful

usually becomes visible from 1 to 4 weeks (but can appear from 3 days to 3 months) after a tick bite and lasts for several weeks

is usually at the site of a tick bite.

NICE has also produced a resource with images showing erythema migrans.

1.2.2 Be aware that a rash, which is not erythema migrans, can develop as a reaction to a tick bite that:

usually develops and recedes during 48 hours from the time of the tick bite

is more likely than erythema migrans to be hot, itchy or painful

may be caused by an inflammatory reaction or infection with a common skin pathogen.

1.2.3 Consider the possibility of Lyme disease in people presenting with several of the following symptoms, because Lyme disease is a possible but uncommon cause of:

fever and sweats

neck pain or stiffness

migratory joint or muscle aches and pain

cognitive impairment, such as memory problems and difficulty concentrating (sometimes described as ‘brain fog’)

1.2.4 Consider the possibility of Lyme disease in people presenting with symptoms and signs relating to 1 or more organ systems (focal symptoms) because Lyme disease is a possible but uncommon cause of:

neurological symptoms, such as facial palsy or other unexplained cranial nerve palsies, meningitis, mononeuritis multiplex or other unexplained radiculopathy; or rarely encephalitis, neuropsychiatric presentations or unexplained white matter changes on brain imaging

inflammatory arthritis affecting 1 or more joints that may be fluctuating and migratory

cardiac problems, such as heart block or pericarditis

eye symptoms, such as uveitis or keratitis

skin rashes such as acrodermatitis chronica atrophicans or lymphocytoma.

1.2.5 If a person presents with symptoms that suggest the possibility of Lyme disease, explore how long the person has had symptoms and their history of possible tick exposure, for example, ask about:

activities that might have exposed them to ticks

travel to areas where Lyme disease is known to be highly prevalent.

1.2.6 Do not rule out the possibility of Lyme disease in people with symptoms but no clear history of tick exposure.

1.2.7 Do not diagnose Lyme disease in people without symptoms, even if they have had a tick bite.

1.2.8 Be cautious about diagnosing Lyme disease in people without a supportive history or positive serological testing because of the risk of:

missing an alternative diagnosis

providing inappropriate treatment.

1.2.9 Follow usual clinical practice to manage symptoms, for example, pain relief for headaches or muscle pain, in people being assessed for Lyme disease.

1.2.10 Take into account that people with Lyme disease may have symptoms of cognitive impairment and may have difficulty explaining their symptoms. For adults, follow the recommendations in NICE’s guideline on patient experience in adult NHS services.

To find out why the committee made the recommendations on clinical assessment and how they might affect practice, see rationale and impact.

Laboratory investigations to support diagnosis

NICE has also produced a visual summary of the recommendations on testing for Lyme disease.

1.2.11 Diagnose and treat Lyme disease without laboratory testing in people with erythema migrans.

1.2.12 Use a combination of clinical presentation and laboratory testing to guide diagnosis and treatment in people without erythema migrans. Do not rule out diagnosis if tests are negative but there is high clinical suspicion of Lyme disease.

1.2.13 If there is a clinical suspicion of Lyme disease in people without erythema migrans:

offer an enzyme-linked immunosorbent assay (ELISA) test for Lyme disease and

consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion.

1.2.14 Test for both IgM and IgG antibodies using ELISAs based on purified or recombinant antigens derived from the VlsE protein or its IR6 domain peptide (such as C6 ELISA).

1.2.15 If the ELISA is positive or equivocal:

perform an immunoblot test for Lyme disease and

consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion of Lyme disease.

1.2.16 If the ELISA for Lyme disease is negative and the person still has symptoms, review their history and symptoms, and think about the possibility of an alternative diagnosis.

1.2.17 If Lyme disease is still suspected in people with a negative ELISA who were tested within 4 weeks from symptom onset, repeat the ELISA 4 to 6 weeks after the first ELISA test.

1.2.18 If Lyme disease is still suspected in people with a negative ELISA who have had symptoms for 12 weeks or more, perform an immunoblot test.

1.2.19 Diagnose Lyme disease in people with symptoms of Lyme disease and a positive immunoblot test.

1.2.20 If the immunoblot test for Lyme disease is negative (regardless of the ELISA result) but symptoms persist, consider a discussion with or referral to a specialist, to:

review whether further tests may be needed for suspected Lyme disease, for example, synovial fluid aspirate or biopsy, or lumbar puncture for cerebrospinal fluid analysis or

consider alternative diagnoses (both infectious, including other tick-borne diseases, and non-infectious diseases).

Choose a specialist appropriate for the person’s history or symptoms, for example, an adult or paediatric infection specialist, rheumatologist or neurologist.

1.2.21 If the immunoblot test for Lyme disease is negative and symptoms have resolved, explain to the person that no treatment is required.

1.2.22 Carry out tests for Lyme disease only at laboratories that:

are accredited by the UK accreditation service (UKAS) and

use validated tests (validation should include published evidence on the test methodology, its relation to Lyme disease and independent reports of performance) and

participate in a formal external quality assurance programme.

1.2.23 Do not routinely diagnose Lyme disease based only on tests done outside the NHS, unless the laboratory used is accredited, participates in formal external quality assurance programmes and uses validated tests (see recommendation 1.2.22). If there is any doubt about tests:

review the person’s clinical presentation and

carry out testing again using a UKAS-accredited laboratory and/or seek advice from a national reference laboratory.

To find out why the committee made the recommendations on laboratory investigations and how they might affect practice, see rationale and impact.

Information for people being tested for Lyme disease

1.2.24 Tell people that tests for Lyme disease have limitations. Explain that both false-positive and false-negative results can occur and what this means.

1.2.25 Explain to people that most tests for Lyme disease assess for the presence of antibodies and that the accuracy of tests may be reduced if:

testing is carried out too early (before antibodies have developed)

the person has reduced immunity, for example, people on immunosuppressant treatments, which might affect the development of antibodies.

1.2.26 Advise people that tests from non-UKAS laboratories may not have been fully evaluated to diagnose Lyme disease.

1.2.27 Explain to people that:

the symptoms and signs associated with Lyme disease overlap with those of other conditions

they will be assessed for alternative diagnoses if their tests are negative and their symptoms have not resolved

symptoms such as tiredness, headache and muscle pain are common, and a specific medical cause is often not found.

To find out why the committee made the recommendations on information, see rationale and impact.

1.3 Management

Emergency referral

1.3.1 Follow usual clinical practice for emergency referrals, for example, in people with symptoms that suggest central nervous system infection, uveitis or cardiac complications such as complete heart block, even if Lyme disease is suspected.

Specialist advice

1.3.2 Discuss the diagnosis and management of Lyme disease in children and young people under 18 years with a specialist, unless they have a single erythema migrans lesion and no other symptoms. Choose a specialist appropriate for the child or young person’s symptoms dependent on availability, for example, a paediatrician, paediatric infectious disease specialist or a paediatric neurologist.

1.3.3 If an adult with Lyme disease has focal symptoms, consider a discussion with or referral to a specialist, without delaying treatment. Choose a specialist appropriate for the person’s symptoms, for example, an adult infection specialist, rheumatologist or neurologist.

To find out why the committee made the recommendations on emergency referral and specialist advice and how they might affect practice, see rationale and impact.

Antibiotic treatment

1.3.4 For adults and young people (aged 12 and over) diagnosed with Lyme disease, offer antibiotic treatment according to their symptoms as described in table 1.

1.3.5 For children (under 12) diagnosed with Lyme disease, offer antibiotic treatment according to their symptoms as described in table 2.

1.3.6 Ask women (including young women under 18) if they might be pregnant before offering antibiotic treatment for Lyme disease (see recommendation 1.3.18 on treatment in pregnancy).

1.3.7 If symptoms worsen during treatment for Lyme disease, assess for an allergic reaction to the antibiotic. Be aware that a Jarisch–Herxheimer reaction may cause an exacerbation of symptoms but does not usually warrant stopping treatment.

1.3.8 Consider clinical review during or after treatment for Lyme disease to assess for possible side effects and response to treatment.

Table 1 Antibiotic treatment for Lyme disease in adults and young people (aged 12 and over) according to symptoms a

Symptoms

Treatment

First alternative

Second alternative

Lyme disease without focal symptoms

Erythema migrans and/or

100 mg twice per day or 200 mg once per day for 21 days

1 g 3 times per day for 21 days

Oral azithromycin b :

500 mg daily for 17 days

Lyme disease with focal symptoms

Lyme disease affecting the cranial nerves or peripheral nervous system

100 mg twice per day or 200 mg once per day for 21 days

1 g 3 times per day for 21 days

Lyme disease affecting the central nervous system

2 g twice per day or 4 g once per day for 21 days (when an oral switch is being considered, use doxycycline)

200 mg twice per day or 400 mg once per day for 21 days

Lyme disease arthritis

100 mg twice per day or 200 mg once per day for 28 days

1 g 3 times per day for 28 days

2 g once per day for 28 days

Acrodermatitis chronica atrophicans

Lyme carditis b

100 mg twice per day or 200 mg once per day for 21 days

2 g once per day for 21 days

Lyme carditis and haemodynamically unstable b

2 g once per day for 21 days (when an oral switch is being considered, use doxycycline)

a For Lyme disease suspected during pregnancy, use appropriate antibiotics for stage of pregnancy.

b Do not use azithromycin to treat people with cardiac abnormalities associated with Lyme disease because of its effect on QT interval.

Table 2 Antibiotic treatment for Lyme disease in children (under 12) according to symptoms a, b, c

Symptoms

Age

Treatment

First alternative

Second alternative

Lyme disease without focal symptoms

Erythema migrans and/or

Oral doxycycline a for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily for 21 days d

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day for 21 days

Oral azithromycin e, f for children 50 kg and under:

10 mg/kg daily for 17 days

Oral amoxicillin for children 33 kg and under: 30 mg/kg 3 times per day for 21 days

Oral azithromycin e, f for children 50 kg and under:

10 mg/kg daily for 17 days

Lyme disease with focal symptoms

Lyme disease affecting the cranial nerves or peripheral nervous system

Oral doxycycline a for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily for 21 days d

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day for 21 days

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day for 21 days

Lyme disease affecting the central nervous system

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 4 g) once per day for 21 days

Oral doxycycline a for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily d

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 4 g) once per day for 21 days

Lyme arthritis or

Acrodermatitis chronica atrophicans

Oral doxycycline a for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 28 days

For severe infections, up to 5 mg/kg daily for 28 days d

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day 28 days

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 2 g) once per day for 28 days

Oral amoxicillin for children, 33 kg and under:

30 mg/kg 3 times per day for 28 days

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 2 g) once per day for 28 days

Lyme carditis and haemodynamically stable f

Oral doxycycline a for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily for 21 days d

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 2 g) once per day for 21 days

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 2 g) once per day for 21 days

Lyme carditis and haemodynamically unstable f

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 2 g) once per day for 21 days

Oral doxycycline a for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily for 21 days d

Intravenous ceftriaxone for children under 50 kg:

80 mg/kg (up to 2 g) once per day for 21 days

a At the time of publication (April 2018), doxycycline did not have a UK marketing authorisation for this indication in children under 12 years and is contraindicated. The use of doxycycline for children aged 9 years and above in infections where doxycycline is considered first line in adult practice is accepted specialist practice. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council’s Prescribing guidance: prescribing unlicensed medicines for further information.

b Discuss management of Lyme disease in children and young people with a specialist, unless they have a single erythema migrans lesion with no other symptoms, see recommendation 1.3.2.

c Children weighing more than the amounts specified should be treated according to table 1.

d Use clinical judgement to determine doses of doxycycline for children under 12 years with severe infections.

e At the time of publication (April 2018), azithromycin did not have a UK marketing authorisation for this indication in children under 12 years. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council’s Prescribing guidance: prescribing unlicensed medicines for further information.

f Do not use azithromycin to treat people with cardiac abnormalities associated with Lyme disease because of its effect on QT interval.

To find out why the committee made the recommendations on antibiotic treatment and how they might affect practice, see rationale and impact.

Ongoing symptoms after a course of antibiotics

1.3.9 If symptoms that may be related to Lyme disease persist, do not continue to improve or worsen after antibiotic treatment, review the person’s history and symptoms to explore:

possible alternative causes of the symptoms

if re‑infection may have occurred

if treatment may have failed

details of any previous treatment, including whether the course of antibiotics was completed without interruption

if symptoms may be related to organ damage caused by Lyme disease, for example, nerve palsy.

1.3.10 If the person’s history suggests re‑infection, offer antibiotic treatment for Lyme disease according to their symptoms (see tables 1 and 2).

1.3.11 Consider a second course of antibiotics for people with ongoing symptoms if treatment may have failed. Use an alternative antibiotic to the initial course, for example, for adults with Lyme disease and arthritis, offer amoxicillin if the person has completed an initial course of doxycycline.

1.3.12 If a person has ongoing symptoms following 2 completed courses of antibiotics for Lyme disease:

do not routinely offer further antibiotics and

consider discussion with a national reference laboratory or discussion or referral to a specialist as outlined in recommendation 1.2.20.

1.3.13 Explain to people with ongoing symptoms following antibiotic treatment for Lyme disease that:

continuing symptoms may not mean they still have an active infection

symptoms of Lyme disease may take months or years to resolve even after treatment

some symptoms may be a consequence of permanent damage from infection

there is no test to assess for active infection and an alternative diagnosis may explain their symptoms.

To find out why the committee made the recommendations on ongoing symptoms after a course of antibiotics and how they might affect practice, see rationale and impact.

Non-antibiotic management of ongoing symptoms

1.3.14 Offer regular clinical review and reassessment to people with ongoing symptoms, including people who have no confirmed diagnosis.

1.3.15 Explore any ongoing symptoms with the person and offer additional treatment if needed following usual clinical practice.

1.3.16 Be alert to the possibility of symptoms related to Lyme disease that may need assessment and management, including:

depression and anxiety (see NICE’s guideline on common mental health problems)

1.3.17 Support people who have ongoing symptoms after treatment for Lyme disease by:

encouraging and helping them to access additional services, including referring to adult social care for a care and support needs assessment, if they would benefit from these

communicating with children and families’ social care, schools and higher education, and employers about the person’s need for a gradual return to activities, if relevant.

To find out why the committee made the recommendations on non-antibiotic management of ongoing symptoms and how they might affect practice, see rationale and impact.

Management for women with Lyme disease during pregnancy and their babies

1.3.18 Assess and diagnose Lyme disease during pregnancy in the same way as for people who are not pregnant. Treat Lyme disease in pregnant women using appropriate antibiotics for the stage of pregnancy [1] .

1.3.19 Tell women with Lyme disease during pregnancy that they are unlikely to pass the infection to their baby and emphasise the importance of completing the full course of antibiotic treatment.

1.3.20 Advise women who had Lyme disease during pregnancy to tell this to their healthcare professional if they have any concerns about their baby. In this situation, healthcare professionals should discuss the history with a paediatric infectious disease specialist and seek advice on what investigations to perform.

1.3.21 Start treatment for Lyme disease under specialist care for babies of women treated for Lyme disease during pregnancy if the baby has IgM antibodies specific for Lyme disease or there is any suspicion the baby may be infected.

To find out why the committee made the recommendations on management for women with Lyme disease during pregnancy and their babies and how they might affect practice, see rationale and impact.

1.4 Information for people with Lyme disease

1.4.1 Explain to people diagnosed with Lyme disease that:

Lyme disease is a bacterial infection treated with antibiotics

most people recover completely

prompt antibiotic treatment reduces the risk of further symptoms developing and increases the chance of complete recovery

it may take time to get better, but their symptoms should continue to improve in the months after antibiotic treatment

they may need additional treatment for symptom relief.

1.4.2 Tell people who are starting antibiotics for Lyme disease that some people may have a Jarisch–Herxheimer reaction to treatment. Explain that:

this causes a worsening of symptoms early in treatment

it can happen when large numbers of bacteria in the body are killed

it does not happen to everyone treated for Lyme disease

they should contact their doctor and keep taking their antibiotics if their symptoms worsen.

1.4.3 Advise people with Lyme disease to talk to their doctor if their symptoms have not improved or if symptoms return after completing treatment.

1.4.4 Explain to people with Lyme disease that infection does not give them lifelong immunity and that it is possible for them to be re‑infected and develop Lyme disease again.

To find out why the committee made the recommendations on information, see rationale and impact.

Terms used in this guideline

Test for Lyme disease

Lyme disease is caused by infection with bacteria from different species of Borrelia. The majority of tests for Lyme disease detect antibodies produced in response to infection by bacteria.

The term Lyme disease is used when referring to both the disease and to tests for an antibody response. This reflects the terminology used in clinical practice.

Jarisch–Herxheimer reaction

This is a systemic reaction, thought to be caused by the release of cytokines when antibiotics kill large numbers of bacteria. Symptoms include a worsening of fever, chills, muscle pains and headache. The reaction can start between 1 and 12 hours after antibiotics are started but can also occur later and can last for a few hours or 1 or 2 days. The reaction is self-limiting and usually resolves within 24 to 48 hours.

It was originally reported in the treatment of syphilis but has been documented in tick-borne diseases including Lyme disease, leptospirosis and relapsing fever.

[1] See the BNF for more information on antibiotics during pregnancy.

www.nice.org.uk

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